Systemic ventricular assist device support in Fontan patients: A report by ACTION

Area of Science:

• Cardiology
• Mechanical Circulatory Support
• Pediatric Heart Failure

Background:

• The Fontan population with end-stage heart failure is increasing.
• Heart transplantation is currently the sole option for these patients.
• Investigating ventricular assist device (VAD) efficacy is crucial.

Purpose of the Study:

• To evaluate the effectiveness of VAD support in Fontan patients with end-stage heart failure.
• To analyze patient characteristics and outcomes following VAD implantation.
• To determine VAD's role as a bridge to transplantation.

Main Methods:

• Retrospective study of Fontan patients within the Advanced Cardiac Therapies Improving Outcomes Network.
• Evaluation of patient demographics, clinical data, and physiological outcomes post-VAD implantation.
• Analysis of adverse events and survival rates at one year.

Main Results:

• 45 Fontan patients received VADs, with a median age of 10 years.
• Most patients had morphologic right ventricle, significant ventricular dysfunction, and atrioventricular valve regurgitation.
• At one year, 69.5% underwent transplantation, 9.2% remained VAD-supported, and 21.3% died. Neurologic events were most common adverse events (25%).

Conclusions:

• VAD support is effective for end-stage Fontan failure patients awaiting heart transplantation.
• VADs can improve hemodynamic parameters in select Fontan patients.
• Future research should identify factors predicting positive VAD response in this population.